By JOHN FAUBER
jfauber@journalsentinel.com
Posted: Aug. 10, 2005
A provocative new study suggests that men with early-stage prostate
cancer who elect not to undergo conventional treatment may be able to halt
the progression of their disease by making substantial lifestyle changes
such as adopting a very low-fat, vegan diet, exercising and meditating.

.

The authors of the study, published today in the Journal of Urology,
say it is the first randomized clinical trial showing that lifestyle changes
can halt the progression of prostate cancer.

However, urologists not associated with the research said the length
of the study was too short, the number of men too few and the outcome measures
too imprecise to make definitive conclusions about the benefits of the
intervention.

In addition, maintaining the strict diet used in the study would be
very difficult for many men, they said.

"I don't know if Draconian is the word," said William See, chairman
of the urology department at the Medical College of Wisconsin. "(But) the
ability of the average Midwesterner to tolerate that kind of diet is questionable."

Growing controversy
The study comes at a time when there is growing controversy about the
best way to treat early-stage, localized prostate cancer. The study and
additional research that may stem from it could have implications for some
of the more than 230,000 men who are diagnosed with prostate cancer each
year. African-American men have a 60% higher risk of developing prostate
cancer than whites and are twice as likely to die of the disease.

Lead author Dean Ornish, director of the Preventive Medicine Research
Institute in Sausalito, Calif., and a longtime crusader of ultra low-fat
diets, said the study shows that adopting various lifestyle changes can
be beneficial to men with prostate cancer in addition to whatever other
conventional measures they take.

"(Improved) diet and lifestyle play a role in the progression of prostate
cancer and the only side effects are good ones," said Ornish, an author
and clinical professor of medicine at the University of California, San
Francisco.

Other study authors included researchers from UCSF and the Memorial
Sloan-Kettering Cancer Center in New York.

"This is the first in a series of trials attempting to better identify
the exact role of diet and lifestyle in the prevention and treatment of
prostate cancer," senior author Peter Carroll, chairman of the urology
department at UCSF, said in a statement.

Earlier epidemiological studies have linked various lifestyle measures
such as a high-fat diet, especially animal fat, obesity and a lack of physical
activity with an increased risk of developing prostate cancer.

There is hope that various dietary measures, such as eating fruits and
vegetables or taking supplements such as lycopene, selenium and vitamin
E, can lower risk, but that evidence still is insufficient, according to
the National Cancer Institute.

Watchful waiting of cancer
The study involved 93 men with an average age of about 66 who were
diagnosed by biopsies with low-grade prostate cancer. All the men had decided
to undergo so-called watchful waiting, which meant their cancer would be
monitored but they would not immediately undergo conventional treatment
such as surgery or radiation.

Forty-four of the men were put into an intensive intervention program
that included a low-fat, vegan diet, and daily tofu and soy supplements,
as well as 400 international units of vitamin E, three grams of fish oil,
200 micrograms of selenium, two grams of vitamin C, 30 minutes of moderate
exercise six days a week, and an hour a day of stress management with techniques
such as meditation and yoga.

The other 49 men did not undergo intensive lifestyle changes.

Researchers used the prostate-specific antigen, or PSA, test as a way
to monitor the disease progression in the men.

After one year, the men in the intervention program had an average 4%
decline in their PSA test scores, compared with a 6% increase in the scores
of the control group.

In another measure, six of the men in the control group went on to have
surgery or some other treatment because of a progression of their disease,
compared with none of the men in the intervention group.

In addition, blood samples were taken from the men to see if the serum
could inhibit prostate cancer tumor growth in a laboratory dish. There
was a 70% inhibition of tumor cell growth from the blood from the men in
the intervention group, compared with 9% from the control group.

"We are learning more and more about compounds that may prevent, if
not have therapeutic potential in prostate cancer," said Jason Gee, a urologic
oncologist at the University of Wisconsin Hospital in Madison. "In a select
group of patients who are appropriate for watchful waiting, some dietary
changes may be helpful as suggested by this study."

However, Gee said it was too early to make overall recommendations based
on the study, which needs to be validated by further research.

'A lot of caveats'
Howard Parnes, a physician with the National Cancer Institute, said
the study's results appear to support the hypothesis that dietary and lifestyle
measures can affect prostate cancer progression, "but there are a lot of
caveats."

One problem, he said, is that the PSA score, the primary measure in
the study, is only a surrogate for disease progression. It is not a clinical
outcome, such as mortality.

The PSA score could have been affected by the soy, which has a weak
hormonal affect, he said.

In addition, there were so many variables in the study that it was impossible
to sort out which ones may have caused the beneficial effects, he said.

However, he said the study was a step in the right direction.

"This kind of work does stimulate the research field to look at dietary
and lifestyle measures," he said.

In addition to lower PSA scores, the men in the intervention group lost
an average of about 10 pounds and had significant improvements in their
cholesterol levels.

In earlier research, Ornish has showed that similar intensive intervention
programs can reverse heart disease.

Prostate Cancer
Anti-Cancer Recipe?
Here is the regimen researchers used on the men whose prostate cancer
appeared to improve:
A low-fat, vegan diet, and daily tofu and soy supplements
400 international units of vitamin E
Three grams of fish oil
• 200 micrograms of selenium
Two grams of vitamin C
30 minutes of moderate exercise six days a week
An hour a day of stress management with techniques such as meditation
and yoga

Factoids
230,000
Number of men who are diagnosed with prostate cancer each year. African-American
men have a 60% higher risk